An evaluation of global Chikungunya clinical management guidelines: A systematic review

Webb, Eika; Michelen, Melina; Rigby, Ishmeala; Dagens, Andrew; Dahmash, Dania; Cheng, Vincent Chi-Chung; Joseph, Reena; Lipworth, Samuel; Harriss, Eli; Cai, Erhui; Nartowski, Robert; Januraga, Pande Putu; Gedela, Keerti; Sukmaningrum, Evi; Çevik, Müge; Groves, Helen; Hart, P. John; Fletcher, Tom; Horby, Peter; Jacob, Shevin T.; Sigfrid, Louise

doi:10.1016/j.eclinm.2022.101672

Cited by 18 publications

(29 citation statements)

References 49 publications

(179 reference statements)

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“…Similar variations in guidance was observed for PEP, with more recently updated guidelines advising use of the newer generation smallpox/MPX vaccines 44 49–51 53 55 56. This highlights a fundamental issue in the development of guidelines for the management of neglected infectious diseases, which was also observed in other reviews42 57 We observe a tendency of guidelines being developed rapidly in response to outbreaks, never to be revisited again, but still being available in public domains. Failure to recall out-of-date guidelines as new evidence emerges, pose a risk to patient care.…”

Section: Discussionsupporting

confidence: 66%

Availability, scope and quality of monkeypox clinical management guidelines globally: a systematic review

et al. 2022

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BackgroundMonkeypox (MPX) is an important human Orthopoxvirus infection. There has been an increase in MPX cases and outbreaks in endemic and non-endemic regions in recent decades. We appraised the availability, scope, quality and inclusivity of clinical management guidelines for MPX globally.MethodsFor this systematic review, we searched six databases from inception until 14 October 2021, augmented by a grey literature search until 17 May 2022. MPX guidelines providing treatment and supportive care recommendations were included, with no exclusions for language. Two reviewers assessed the guidelines. Quality was assessed using the Appraisal of Guidelines for Research and Evaluation II tool.ResultsOf 2026 records screened, 14 guidelines were included. Overall, most guidelines were of low-quality with a median score of 2 out of 7 (range: 1–7), lacked detail and covered a narrow range of topics. Most guidelines focused on adults, five (36%) provided some advice for children, three (21%) for pregnant women and three (21%) for people living with HIV. Treatment guidance was mostly limited to advice on antivirals; seven guidelines advised cidofovir (four specified for severe MPX only); 29% (4/14) tecovirimat, and 7% (1/14) brincidofovir. Only one guideline provided recommendations on supportive care and treatment of complications. All guidelines recommended vaccination as post-exposure prophylaxis (PEP). Three guidelines advised on vaccinia immune globulin as PEP for severe cases in people with immunosuppression.ConclusionOur results highlight a lack of evidence-based clinical management guidelines for MPX globally. There is a clear and urgent need for research into treatment and prophylaxis including for different risk populations. The current outbreak provides an opportunity to accelerate this research through coordinated high-quality studies. New evidence should be incorporated into globally accessible guidelines, to benefit patient and epidemic outcomes. A ‘living guideline’ framework is recommended.PROSPERO registration numberCRD42020167361.

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Section: Discussionsupporting

confidence: 66%

Availability, scope and quality of monkeypox clinical management guidelines globally: a systematic review

et al. 2022

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“…The treatment of uncomplicated, acute forms of chikungunya fever only requires resting, oral hydration and simple, well-conducted analgesia 153,240 . Outpatient care at home is also possible and recommended by WHO 241 . It is also important to distinguish those patients presenting with simple forms of chikungunya fever from those presenting with severe forms that require hospitalization and monitoring in a specialized environment.…”

Section: Management Of Acute Chikungunya Fevermentioning

confidence: 99%

Chikungunya fever

Bartholomeeusen

Daniel²,

LaBeaud

et al. 2023

Nat Rev Dis Primers

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Chikungunya virus is widespread throughout the tropics, where it causes recurrent outbreaks of chikungunya fever. In recent years, outbreaks have afflicted populations in East and Central Africa, South America and Southeast Asia. The virus is transmitted by Aedes aegypti and Aedes albopictus mosquitoes. Chikungunya fever is characterized by severe arthralgia and myalgia that can persist for years and have considerable detrimental effects on health, quality of life and economic productivity. The effects of climate change as well as increased globalization of commerce and travel have led to growth of the habitat of Aedes mosquitoes. As a result, increasing numbers of people will be at risk of chikungunya fever in the coming years. In the absence of specific antiviral treatments and with vaccines still in development, surveillance and vector control are essential to suppress re-emergence Nature Reviews Disease Primers | (2023) 9:17 2 0123456789();: PrimerWith the increasing global distribution of the Aedes mosquitoes and their ability to adapt to urban settings, the urban transmission cycle is increasingly important. Here, during a blood meal on an infected person, the female mosquito ingests the virus, which infects various mosquito tissues, including the salivary glands. During a subsequent blood meal by the infected mosquito, the virus is deposited in the skin of an uninfected person along with mosquito saliva, infecting the person and perpetuating the viral replication cycle 14 . Phylogenetic analysis identified three distinct lineages corresponding to their respective geographical origin: West African, East Central South African (ECSA) and Asian lineage 15,16 . The ECSA lineage is further divided into two clades: ECSA1, which consists entirely of ancestral CHIKV sequences, and ECSA2, which contains sequences from the Central African Republic, Cameroon, Gabon and the Republic of Congo 17,18 . Since its discovery in 1952, CHIKV has been reported to be circulating and causing sporadic outbreaks in sub-Saharan Africa. In 2004, an ECSA CHIKV strain emerged in Kenya and subsequently spread to the Indian Ocean Islands, where it caused outbreaks of an unprecedented magnitude, particularly in La Réunion [19][20][21][22][23][24] . The extent of this outbreak has led to the emergence of a fourth phylogenetic lineage termed Indian Ocean lineage, which has subsequently dispersed to Asia and India 25 and caused autochthonous transmission (local disease spread) in Mediterranean Europe (Italy and France) 26,27 .In December 2013, another major outbreak occurred when a strain from the Asian lineage emerged for the first time on the Caribbean Saint Martin Island, from where the virus spread to more than 50 countries of the South American continent, causing a conservatively estimated 1 million infections 28,29 . In 2014, the ECSA lineage was reported in Northeast Brazil, where it continues to circulate as the most prevalent strain today 30 .Most of the Indian Ocean lineage is characterized by an adaptive mutation in the E1 glycopr...

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“…On the other hand, pharmacologic therapies use medications to treat symptoms, such as joint pain and fever [106,157]. Webb et al reviewed the global Clinical Management Guidelines (CMGs) for chikungunya infection, reporting a lack of consistency in the classification of disease stages [158]. They also highlighted a variation in the prescriptions of corticosteroids and Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) [158], which are essential in symptomatic treatment for individuals infected with the chikungunya virus [159].…”

Section: Resultsmentioning

confidence: 99%

“…Webb et al reviewed the global Clinical Management Guidelines (CMGs) for chikungunya infection, reporting a lack of consistency in the classification of disease stages [158]. They also highlighted a variation in the prescriptions of corticosteroids and Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) [158], which are essential in symptomatic treatment for individuals infected with the chikungunya virus [159]. Despite having a low risk of mortality, the chikungunya virus can be lethal for children and the elderly [160,161].…”

Section: Resultsmentioning

confidence: 99%

“…Despite having a low risk of mortality, the chikungunya virus can be lethal for children and the elderly [ 160 , 161 ]. The current CMGs for these vulnerable population groups, on the other hand, were limited and varied [ 158 ]. Transmission of the chikungunya virus could also be prevented by cutting the reproductive cycles of the vectors, A. aegypti and A. albopictus [ 154 , 162 ].…”

Section: Discussionmentioning

confidence: 99%

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Growth in chikungunya virus-related research in ASEAN and South Asian countries from 1967 to 2022 following disease emergence: a bibliometric and graphical analysis

et al. 2023

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Background ASEAN (Association of Southeast Asian Nations) is composed of ten Southeast Asian countries bound by socio-cultural ties that promote regional peace and stability. South Asia, located in the southern subregion of Asia, includes nine countries sharing similarities in geographical and ethno-cultural factors. Chikungunya is one of the most significant problems in Southeast and South Asian countries. Much of the current chikungunya epidemic in Southeast Asia is caused by the emergence of a virus strain that originated in Africa and spread to Southeast Asia. Meanwhile, in South Asia, three confirmed lineages are in circulation. Given the positive correlation between research activity and the improvement of the clinical framework of biomedical research, this article aimed to examine the growth of chikungunya virus-related research in ASEAN and South Asian countries. Methods The Scopus database was used for this bibliometric analysis. The retrieved publications were subjected to a number of analyses, including those for the most prolific countries, journals, authors, institutions, and articles. Co-occurrence mapping of terms and keywords was used to determine the current state, emerging topics, and future prospects of chikungunya virus-related research. Bibliometrix and VOSviewer were used to analyze the data and visualize the collaboration network mapping. Results The Scopus search engine identified 1280 chikungunya-related documents published by ASEAN and South Asian countries between 1967 and 2022. According to our findings, India was the most productive country in South Asia, and Thailand was the most productive country in Southeast Asia. In the early stages of the study, researchers investigated the vectors and outbreaks of the chikungunya virus. In recent years, the development of antivirus agents has emerged as a prominent topic. Conclusions Our study is the first to present the growth of chikungunya virus-related research in ASEAN and South Asian countries from 1967 to 2022. In this study, the evaluation of the comprehensive profile of research on chikungunya can serve as a guide for future studies. In addition, a bibliometric analysis may serve as a resource for healthcare policymakers.

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An evaluation of global Chikungunya clinical management guidelines: A systematic review

Cited by 18 publications

References 49 publications

Availability, scope and quality of monkeypox clinical management guidelines globally: a systematic review

Availability, scope and quality of monkeypox clinical management guidelines globally: a systematic review

Chikungunya fever

Growth in chikungunya virus-related research in ASEAN and South Asian countries from 1967 to 2022 following disease emergence: a bibliometric and graphical analysis

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